31 May Study Finds Single Antibiotic Cephalexin Alone Is Appropriate Outpatient Treatment For Cellulitis

MedicalResearch.com Interview with:
Gregory John Moran, MD, FACEP
Emergency Medicine Dept. & Infectious Diseases Service
UCLA Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The bacterial etiology of cellulitis is difficult to determine because there is usually no material for culture, but streptococci are believed to be the most common etiology. Since the emergence of MRSA as a common cause of skin infections in the community, many clinicians add a second antibiotic with MRSA activity to an oral cephalosporin, such as a combination of cephalexin plus trimethoprim-sulfamethoxazole. It is unknown if there is an additional benefit to adding MRSA activity for treatment of cellulitis. This randomized, blinded trial compared cephalexin plus placebo to cephalexin plus trimethoprim-sulfamethoxazole for outpatient treatment of cellulitis without an abscess or wound.

Bottom line: We did not find a benefit from addition of trimethoprim-sulfamethoxazole.

MedicalResearch.com: What should readers take away from your report?

Response: Cephalexin alone is appropriate outpatient treatment for cellulitis. Our study does not rule out the possibility that there may be some patients who could benefit from the addition of trimethoprim-sulfamethoxazole. Note that we did bedside ultrasound in the ED to rule out an occult abscess. While some treatment failures did develop an abscess at followup and had cultures positive for MRSA, the proportion of cases with MRSA did not differ between treatment groups.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: In the Intention-to-treat group analysis, the confidence interval included the possibility of a clinically significant benefit to the addition of trimethoprim-sulfamethoxazole to cephalexin. Similar trials could more precisely determine whether there may be a benefit to addition of trimethoprim-sulfamethoxazole for some patients.

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Citation:

Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis: A Randomized Clinical Trial.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on May 31, 2017 by Marie Benz MD FAAD